Blame the Docs: Errors Cloud Medicare Payment Data

Two doctors top the list of emergency medicine specialists in the Medicare doctor payment data released last week, with reimbursements over $1 million each.

But it turns out both doctors are vascular surgeons who identified themselves as the wrong specialty. And it's not just the "case of the mistaken specialties." Other physicians report outdated data, missing records, and different addresses.

Experts say the errors are manageable and mostly not Medicare's fault.

"I think it's reliably accurate, whenever there's an inaccuracy there's always an explanation," said Charles Ornstein, senior reporter for ProPublica, which produced the Dollars for Docs project based on similar Medicare data. "When they're wrong, it's often on doctors themselves or their practices in the way they do their billing. Doctors are notorious for not keeping their NPPES [National Plan and Provider Enumeration System] updated."

For example, when I Googled Seth Fritcher, MD and Daniel Mountcastle, MD, one was affiliated with Peripheral Vascular Associates, and the other, Mountcastle Vein Centers. Of course, I called to make sure I hadn't misunderstood. Fritcher was in clinic, but the receptionist confirmed he is not an emergency physician.

Mountcastle runs four clinics in Florida. While on hold, I heard a message that assured callers that "most of our treatments are covered by most insurance, including Medicare." Mountcastle's office manager said he was identified as an emergency physician because he used to be one, but verified the clinics now just treat varicose and spider veins.

For reference, Fritcher was reimbursed for $1.8 million and Mountcastle, $1 million, compared with the most reimbursed vascular specialist at $10 million. The highest reimbursed emergency physician was $814,000.

In emergency medicine, I discovered the problems quickly. I was looking at a list of just 28 doctors whom Medicare reimbursed over $500,000, courtesy of WCG. But when there's a list of 151 vascular specialists, potential errors make it difficult to parse, and potentially skew data interpretation.

Beyond scrutiny of outliers, the implications of data rife with such errors is unclear. "It is a lot more like the line on the door frame that parents draw as their kids grow," said said Fred Trotter, a data journalist who blogs at O'Reilly, and also co-wrote "Hacking Healthcare." "It is a snapshot in time of a dynamically changing system."

"Type of doctor" is self-selected and not ever verified by Medicare, Trotter said. "Lots of doctors delegate the maintenance of their NPPES records to low-paid staff members who really have no understanding of the difference between a cardiologist and a cardiac surgeon," Trotter wrote in an email.

In some cases, doctors who treat a lot of seniors may not know exactly how the patients are enrolled, and may be reimbursed in a different way, Ornstein said. Another quirk is that Medicare chose to use doctors' addresses as they were reported in 2012, which may have thrown some physicians off.

Still, Christopher Tashjian, MD, who practices in Ellsworth, Wisconsin, told MedPage Today that a surgeon in his practice discovered that the "data was out of date" and was reported from a previous practice 4 years ago.

"Physicians should have been allowed to review the data and ask clarifying questions/appeal errors before any public release," said Jim Rohack, MD, a cardiologist and chief health policy officer at Baylor Scott & White Health, and former president of the American Medical Association.

All these confounders add to the frustration of many doctors who are trying to determine how best to make sense of and respond to the data release.

"Collecting data on this scale is a massive task," said Jeanne Pinder, founder of medical price transparency site Clear Health Costs. "The whole idea is to collect data and then use it to understand treatment patterns, and to encourage value in healthcare, as well as rooting out fraud and waste. We've seen Medicare data before, and we know it's messy, so we're not totally surprised."

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